Provider Demographics
NPI:1902465776
Name:NOVOGRAD, LEAH GAIL (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:GAIL
Last Name:NOVOGRAD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 SIMMONDS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3822
Mailing Address - Country:US
Mailing Address - Phone:410-466-3344
Mailing Address - Fax:
Practice Address - Street 1:6100 CROSS COUNTRY BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3704
Practice Address - Country:US
Practice Address - Phone:410-396-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MD03335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist